Coagulopathy and haemorrhagic progression in traumatic brain injury: advances in mechanisms, diagnosis, and management

Research output: Contribution to journalReview article

Standard

Coagulopathy and haemorrhagic progression in traumatic brain injury : advances in mechanisms, diagnosis, and management. / Maegele, Marc; Schöchl, Herbert; Menovsky, Tomas; Maréchal, Hugues; Marklund, Niklas; Buki, Andras; Stanworth, Simon.

In: The Lancet Neurology, Vol. 16, No. 8, 01.08.2017, p. 630-647.

Research output: Contribution to journalReview article

Harvard

APA

CBE

MLA

Vancouver

Author

Maegele, Marc ; Schöchl, Herbert ; Menovsky, Tomas ; Maréchal, Hugues ; Marklund, Niklas ; Buki, Andras ; Stanworth, Simon. / Coagulopathy and haemorrhagic progression in traumatic brain injury : advances in mechanisms, diagnosis, and management. In: The Lancet Neurology. 2017 ; Vol. 16, No. 8. pp. 630-647.

RIS

TY - JOUR

T1 - Coagulopathy and haemorrhagic progression in traumatic brain injury

T2 - advances in mechanisms, diagnosis, and management

AU - Maegele, Marc

AU - Schöchl, Herbert

AU - Menovsky, Tomas

AU - Maréchal, Hugues

AU - Marklund, Niklas

AU - Buki, Andras

AU - Stanworth, Simon

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Normal haemostasis depends on an intricate balance between mechanisms of bleeding and mechanisms of thrombosis, and this balance can be altered after traumatic brain injury (TBI). Impaired haemostasis could exacerbate the primary insult with risk of initiation or aggravation of bleeding; anticoagulant use at the time of injury can also contribute to bleeding risk after TBI. Many patients with TBI have abnormalities on conventional coagulation tests at admission to the emergency department, and the presence of coagulopathy is associated with increased morbidity and mortality. Further blood testing often reveals a range of changes affecting platelet numbers and function, procoagulant or anticoagulant factors, fibrinolysis, and interactions between the coagulation system and the vascular endothelium, brain tissue, inflammatory mechanisms, and blood flow dynamics. However, the degree to which these coagulation abnormalities affect TBI outcomes and whether they are modifiable risk factors are not known. Although the main challenge for management is to address the risk of hypocoagulopathy with prolonged bleeding and progression of haemorrhagic lesions, the risk of hypercoagulopathy with an increased prothrombotic tendency also warrants consideration.

AB - Normal haemostasis depends on an intricate balance between mechanisms of bleeding and mechanisms of thrombosis, and this balance can be altered after traumatic brain injury (TBI). Impaired haemostasis could exacerbate the primary insult with risk of initiation or aggravation of bleeding; anticoagulant use at the time of injury can also contribute to bleeding risk after TBI. Many patients with TBI have abnormalities on conventional coagulation tests at admission to the emergency department, and the presence of coagulopathy is associated with increased morbidity and mortality. Further blood testing often reveals a range of changes affecting platelet numbers and function, procoagulant or anticoagulant factors, fibrinolysis, and interactions between the coagulation system and the vascular endothelium, brain tissue, inflammatory mechanisms, and blood flow dynamics. However, the degree to which these coagulation abnormalities affect TBI outcomes and whether they are modifiable risk factors are not known. Although the main challenge for management is to address the risk of hypocoagulopathy with prolonged bleeding and progression of haemorrhagic lesions, the risk of hypercoagulopathy with an increased prothrombotic tendency also warrants consideration.

UR - http://www.scopus.com/inward/record.url?scp=85023179398&partnerID=8YFLogxK

U2 - 10.1016/S1474-4422(17)30197-7

DO - 10.1016/S1474-4422(17)30197-7

M3 - Review article

VL - 16

SP - 630

EP - 647

JO - Lancet Neurology

JF - Lancet Neurology

SN - 1474-4465

IS - 8

ER -